Diabetes Report Card 2012: National and State Profile of Diabetes and Its Complications
 

CDC and HHS Respond to Diabetes
 

As the leading public health agency for HHS, CDC has a unique role in preventing, controlling, and managing diabetes. CDC provides public health leadership to translate evidence-based science on what works into practice to improve health outcomes for people with diabetes and those at risk of developing type 2 diabetes. The agency also analyzes data to measure the burden of diabetes, conducts and funds research, works to reduce health disparities, and creates a variety of educational resources.

In its scientific and programmatic activities, CDC works to reduce differences in health status and health care that are based on race, ethnicity, economic status, or other factors. The agency provides information on health disparities to raise awareness about how diabetes care can reduce health gaps. CDC partners with national, tribal, territorial, state, and local organizations to support programs to prevent and control diabetes.

In addition to CDC’s efforts, HHS works through all of its relevant agencies and programs to fight the diabetes epidemic by using a broad range of research, education, and programs that strengthen the prevention, detection, and treatment of diabetes. Efforts to address diabetes across HHS will improve care for people living with diabetes today and help prevent the onset of diabetes in more Americans in the future.
 

Supporting Diabetes Prevention and Control
 

Empowering Patients with Tools and Resources

• Affordable Care Act and Diabetes Benefits: The health care law expands insurance coverage, consumer protections, and access to primary care. For example, important preventive services are now covered with no cost sharing in most private plans if the service is graded A (strongly recommended) or B (recommended) by the U.S. Preventive Services Task Force (USPSTF). These services include type 2 diabetes screening, diet counseling, and blood pressure screening. In addition, immunizations recommended by the Advisory Committee on Immunization Practices and other recommended preventive services that are specifically for children, youth, and women will also be covered with no cost sharing by many private health plans.
  
  Beginning in 2013, state Medicaid programs that eliminate cost sharing for these clinical preventive services may receive enhanced federal matching funds. Medicare now covers certain preventive services recommended by the USPSTF with no cost sharing, as well as an annual wellness visit that includes a personalized prevention plan at no additional cost to beneficiaries.
   
• Medicare and Diabetes Preventive Benefits: Medicare covers diabetes screening tests to identify beneficiaries with diabetes or at high risk of developing diabetes. Medicare also covers screening for glaucoma, which may be a comorbidity of diabetes. Other Medicare preventive benefits (e.g., diabetes self-management training, medical nutrition therapy) support beneficiaries in self-care and in making lifestyle changes to prevent or minimize development of the comorbidities and complications of diabetes. These benefits are available both to people with traditional Medicare and those enrolled in Medicare Advantage plans. In addition, Medicare prescription drug plans (Part D) cover insulin and other medications that may be needed for diabetes self-management.
   
• Medicare Diabetes Special Needs Plans: Within Medicare Advantage, 36 Special Needs Plans (SNPs) focused on chronic care, known as chronic condition SNPs (C-SNPs), are being offered in 2012 specifically for Medicare beneficiaries with diabetes. These C-SNPs may offer extra benefits, and they use a model of care approved by the Centers for Medicare & Medicaid Services (CMS) that is designed to support and improve the health status of beneficiaries with diabetes. In addition, regular Medicare Advantage plans may offer supplemental benefits that go beyond those covered by traditional Medicare.
  
  These benefits may include the following:
  
• Health education for all beneficiaries as a way to prevent diabetes.
• Extra self-care skills training for those with diabetes.
• Focused disease management programs that provide care coordination and in-home monitoring to prevent development of comorbidities and complications of diabetes.
   
• Medicare’s Everyone with Diabetes Counts Program: The CMS developed the Everyone with Diabetes Counts program to help Medicare beneficiaries with diabetes who are members of vulnerable populations actively participate in their care. Beneficiaries complete diabetes self-management education classes that focus on basic anatomy, healthy lifestyles, healthy nutrition choices, and the importance of eye exams, foot exams, and regular laboratory tests such as hemoglobin A1c and lipid panels. Classes are taught in community locations. To date, more than 20,000 Medicare beneficiaries have completed classes through this program.
   
• Lower Extremity Amputation Prevention Program (LEAP): This program is designed to reduce lower-extremity amputations in people with diabetes, Hansen’s disease, or other conditions that result in loss of protective sensation in the feet. LEAP is a five-step program that includes annual foot screenings, patient education, daily self-inspection, footwear selection, and management of simple foot problems.
   
• Chronic Disease Self-Management Program: The U.S. Administration for Community Living, in collaboration with CDC and CMS, directs this program, which enables older Americans with chronic diseases, such as diabetes, to learn how to manage their conditions and take control of their health. State units on aging and state health departments work with their state Medicaid agency and local partners to increase availability and access to these self-management tools and programs, especially among low-income, minority, and other underserved populations. Local partners include senior centers, meal programs, faith-based organizations, libraries, YMCAs, YWCAs, and senior housing programs.
   
• Healthfinder.gov: This award-winning prevention Web site includes tools to help people take steps to prevent diabetes. Information is based on USPSTF recommendations, HHS’s Dietary Guidelines for Americans, 2010 and 2008 Physical Activity Guidelines for Americans, and other preventive initiatives.
  

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Investing in Opportunities to Combat Diabetes

• Innovation Awards: The Health Care Innovation Awards announced by the CMS Innovation Center include multiple projects that specifically target diabetes. Examples include projects designed to improve the care and oral health of American Indians with diabetes on South Dakota reservations; reduce death and disability from type 2 diabetes among underserved and at-risk populations in the southeast portion of North Carolina; and use community health workers to help prevent the progression of diabetes in underserved populations in New Mexico, Pennsylvania, and the District of Columbia.
  
  Other projects include implementing and testing a care coordination and health information technology plan to improve the health of Medicaid-eligible patients with type 1 and type 2 diabetes in Hawaii and using collaborative partnerships to address diabetes in a multicultural, high-risk, high-cost population in San Mateo County, California.
   
• Medicaid Incentives for the Prevention of Chronic Diseases: Seven of the ten states that have received Medicaid Incentives for the Prevention of Chronic Diseases grants (California, Hawaii, Minnesota, Montana, Nevada, New York, and Texas) are focused on diabetes management or prevention. The target population is Medicaid beneficiaries aged 18 years or older with diabetes. Prevention programs and incentives focus on demonstrating changes in health risk and outcomes, including the adoption of healthy behaviors.
   
• CDC’s State-Based Diabetes Prevention and Control Programs: In all 50 states, the District of Columbia, 6 Pacific territories/former territories, Puerto Rico, and the U.S. Virgin Islands, CDC funding and technical assistance for diabetes programs support activities to
  
• Improve health outcomes for people living with diabetes by preventing health complications among those most at risk.
• Adopt diabetes care guidelines in health care settings
• Help state Medicaid programs monitor quality care outcomes among people with diabetes.
• Educate health care providers, public health professionals, and the public about optimal diabetes care and self-management.
• Involve communities in diabetes prevention and control activities.

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Creating Partnerships to Combat Diabetes

• National Diabetes Prevention Program: The Afford­able Care Act established CDC’s National Diabetes Prevention Program (National DPP), a public-private partnership of community organizations, private insurers, employers, health care organizations, and government agencies working together to combat diabetes. Through this program, people who are at risk of developing type 2 diabetes work with a lifestyle coach in a group setting during the year-long program. The group classes are offered through community-based organizations, wellness centers, and faith-based organizations.
  
  The inaugural partners of the National DPP were the YMCA and UnitedHealth Group. The National DPP’s goal is to reach 15 million people with prediabetes by 2020 to prevent them from developing type 2 diabetes or to diagnose them in early stages to avoid long-term health complications.
   
• National Prevention Strategy: The U.S. Surgeon General led an effort by 17 federal departments to develop the first-ever U.S. National Prevention and Health Promotion Strategy, as directed by the Affordable Care Act. The goal is to increase the number of Americans who are healthy at every stage of life by identifying evidenced-based recommendations to prevent chronic diseases such as diabetes. The National Prevention, Health Promotion and Public Health Council, its Advisory Group, and private and public partners are working together to implement the strategy at national, state, tribal, and local levels and to recognize the importance of engaging all sectors of society in improving the health and well-being of communities. Key indicators for successful implementation are drawn from Healthy People 2020 objectives and targets.

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Engaging Communities to Address Diabetes and Reduce Health Disparities

• HHS Office of Minority Health/American Diabetes Association Partnership: The Office of Minority Health and the American Diabetes Association are collaborating to reduce amputations due to diabetes in minority populations. The aim of this partnership is to increase awareness about proper foot care and help patients of color, who experience higher rates of lower-extremity amputations, access the care they need to prevent amputations.
   
• Community Transformation Grant Program: Created by the Affordable Care Act and funded by the Prevention and Public Health Fund, the Community Transformation Grant program supports state and community efforts to address chronic health conditions, including diabetes, and to reduce chronic disease risk factors. These grants address a range of chronic diseases (including diabetes) and risk factors (such as obesity) and are designed to improve health, reduce health disparities, and control health care spending.
   
• National Institutes of Health’s (NIH’s) We Can! Initiative: This national initiative is designed to give parents, caregivers, and entire communities a way to help children aged 8–13 years maintain a healthy weight. It provides parents and caregivers with tools, activities, and more to help them encourage healthy eating and increased physical activity. The We Can! Initiative also offers organizations, community groups, and health professionals a centralized resource to promote a healthy weight in youth through community outreach, partnership development, and media activities that can be adapted to meet the needs of diverse populations.
   
• Indian Health Service (IHS) Special Diabetes Program for Indians: The Special Diabetes Program for Indians (SDPI) is a $150 million annual program that provides grants for diabetes prevention and treatment services to 400 IHS, tribal, and urban health programs for Native Americans. The SDPI has three major components: community-directed grants for diabetes prevention and treatment, Diabetes Prevention and Healthy Heart Initiative grants, and data infrastructure improvement for the IHS.
   
• Partnerships Active in Communities to Achieve Health Equity Program: This Office of Minority Health program seeks to improve health outcomes among racial and ethnic minorities through community-based networks that adopt evidence-based disease management and preventive health activities and increase access to and use of preventive health care, medical treatment, and supportive services. Several grantees are working to improve the prevention, detection, and management of diabetes.
  

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Conducting Diabetes Research
 

Investing in Research to Better Understand Diabetes

• NIH Diabetes Research: NIH is the primary source of federal support for diabetes research. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is the lead NIH component for supporting diabetes research. Diabetes research funded by NIH is supported by regularly appropriated funds that HHS receives through the Subcommittee on Labor-HHS-Education Appropriations. It is also supported by the Special Statutory Funding Program for Type 1 Diabetes Research, which is a special appropriation to the Secretary of HHS to pursue research on type 1 diabetes and its complications. Total NIH funding for diabetes research is approximately $1 billion.
   
• CDC Diabetes Prevention and Control Research: CDC studies trends in diabetes, related health outcomes, and new developments in treatment and prevention. CDC’s research also plays an important role in determining which programs are most effective in preventing and controlling diabetes and which are cost effective or can even save money. Research findings are used by CDC, state, territorial, local, and tribal public health programs and a variety of health care system partners to prioritize diabetes prevention and control interventions.
  
  CDC’s research in this area includes the SEARCH for Diabetes in Youth Study (SEARCH) and the Natural Experiments for Translation in Diabetes (NEXT-D) Study. SEARCH is a national, multicenter study that is the most complete examination of diabetes, both type 1 and type 2, in children and young adults ever conducted in the United States.¹⁶ The NEXT-D Study is a national, multicenter study that uses an observational approach to examine which policy changes initiated by health care systems, business and community organizations, and legislatures are improving the health of people with diabetes. The research approach is unique, and the results will help researchers identify which health policy initiatives and actions are working.¹⁷
   
• NIH’s Diabetes Prevention Program (DPP): The results of this clinical research study, which were published in 2002, contributed to a better understanding of how type 2 diabetes develops in people at risk and how they can prevent or delay the development of diabetes by making behavioral changes that lead to weight loss. The positive effects of the DPP continue as new research—building on the study’s results—seeks the most effective ways to prevent, delay, or even reverse diabetes. This research provided evidence for programs being implemented through CDC’s National Diabetes Prevention Program.
  

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Providing Management and Support
 

Educating the Nation About Diabetes

• National Diabetes Information Clearinghouse (NDIC): The NDIC is a service of NIDDK. Established in 1978, the NDIC provides information about diabetes to people with diabetes, their families, health care professionals, and the public. It answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and government agencies to coordinate resources on diabetes.
   
• National Diabetes Education Program (NDEP): The NDEP is jointly sponsored by CDC and NIH. It develops and provides educational tool kits and multimedia resources for a variety of audiences, including health care professionals and diabetes educators. It has more than 200 federal, state, and local partners that work together to improve the treatment and outcomes for people with diabetes, promote early diagnosis, and prevent or delay the onset of type 2 diabetes. Program audiences include those with and at risk of diabetes, health care professionals, and employers.
  

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Measuring the Public Health Impact
 

Tracking Progress

• Healthy People 2020: This national health agenda is tracking progress toward meeting several diabetes-related objectives during this decade. The overall goal is to reduce the disease and economic burden of diabetes and improve the quality of life for all people who have or are at risk of diabetes.

Mapping the Country

• National Diabetes Surveillance System: Through this system, CDC analyzes national trends and provides state and county data. Public health professionals and communities can use these data to focus their diabetes prevention and control efforts on areas of greatest need. CDC connects state and local health departments across the United States by monitoring disease patterns and sharing information that improves state responses to diabetes.

Reducing Disparities and Tracking Quality

• National Healthcare Disparities Report and National Healthcare Quality Report: These reports from the Agency for Healthcare Research and Quality track the health care system through quality measures such as the percentage of U.S. adults receiving care for diabetes. For example, the 2011 National Healthcare Quality Report showed that only one of five adults with diabetes in 2008 had received all four recommended services (foot exam, dilated eye exam, flu shot, and two hemoglobin A1c tests) within the calendar year.
  

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